what a roller coaster - DKA

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klescinsky

klescinsky

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Well, I joined when we got a preliminary diagnosis in April this year. We had just moved, kitties were stressed (humans too), and Lois tested really high. Had picked a vet that was open and went, got blood work, and had a very bad experience. She improved over the next week, and when we went back to the new vet I had researched and chosen, her sugar was high normal. They looked at her history, and had me come back a couple times, and said she was borderline and would bear watching.

She had blood work several times between then and now. Glucose always tested high normal, I'd ask, and they'd say no, not a diabetic, borderline.

They were WRONG! And it makes me SO ANGRY that I listened to them. I didn't want it to be diabetes. I wanted her to be OK. I should have known better. But she looked better, and was acting like she felt better, and she had regained weight and was doing so well.

This past weekend she started acting off, and by Monday I had to take her to the vet. Did a full panel, and her numbers were bad, but all over the place - Glucose 400+ and kidney and liver values showing major issues, but the vet didn't know exactly what it was. Did a urinalysis, and ketones extremely high. Yep, nasty DKA reared it's ugly head. I don't have copies of any of the lab work, I was so upset and she was so condescending. Told me that Lois required immediate hospitalization, and that I was looking at $10K, and otherwise she wouldn't survive the night. I was devastated. They were pressuring me to hand over my cat and pay them $5k immediately and told me that her prognosis was extremely poor even with the treatment. I asked if she was suffering - she said no (the liar!) and I took her home, thinking she was going to die. Sobbed my eyes out. Held her in my arms all night, and watched her every breath. Morning came, and sweet Lois was still with me, although obviously very weak. Called the vet to make the dreaded appointment for 5pm - the latest I could put it off. My husband called me at 4, and told me that he couldn't let me do it. So we took her to a specialty clinic, had bloodwork done, and got a second opinion. My darling husband was saving for a vacation, and used that money to pay for my baby's care. She's still in the ICU there, but off the IV now and on Lantus now. They want to keep her through Monday to make sure she's regulated. I've found a friend of my breeder who suggested a new vet, since this is an emergency hospital only.

So we are starting this journey together, and I'm scared, but coming so close to losing Lois really reminded me how precious she is to us. She's a fighter and is doing fantastic, so I owe it to her to learn how to do my part.
 
Re: what a roller coaster

Oh Kris, I am so sorry this nightmare happened to you and your sweet Lois. It does sound like she is in a good situation. DKA is very scary but we have had many cats do fine and recover completely. I would add DKA to your subject line. (go back to your original post and choose edit). Someone who has dealt with it can give you specific advice.

Don't beat yourself up. You're not a vet. They are supposed to be the ones that know. And you kept at it until you got her in a good place. (give that sweet hubby of yours a extra hug from me)

We can help you with the diabetes once she gets home. It is really very manageable. Keep reading and asking questions so you will be ready for her return.
 
Well, they think she will come home on Monday night. I am going to meet with the vet tomorrow when I visit her, I have a list of questions, and want to talk them through with her, and be able to work through digesting that before I bring Lois home. They've totally changed her diet, which is fine, but I need to know what it is so I can buy some before I get her home. We have 3 cats - one is an 18 y/o with kidney issues, and a gorgeously healthy 4 y/o Maine Coon. I don't want to leave any food out that will hurt Lois, but the MC isn't a big fan of wet food, so I have to find a high place for the kibble. Lois doesn't climb.

You know that it's gonna be a few days before I can leave her out of my sight, right? Luckily I work from home, and she assists me so she is used to being with me most of the day.
 
Oh, I would be mad at those vets, too. Especially the condescending one. My cat was hospitalized with DKA and spent 8 1/2 days hospitalized at the University of Pennsylvania School of Veterinary Medicine. I was told that they were good, but that they were expensive. The cost was less than $5,000. I want you to give your hubby an extra warm hug from me, too.

I can tell how much you love your kitty. :YMHUG: I'm so glad you are treating her, and found a better vet hospital to take her to.

We'll help you, once she's out. And, you can come here for support, and guidance, anytime.
 
DKA is an awful experience. I totally understand what you are going through. Garland spent 8 days in the ER with it. (costs were around $5000) The DKA actually pushed her into FHL bc she wasnt eating and we had to get an e-tube. We just had a another DKA scare last week. Her ketones were really high. I had to fight them here at home to bring them down before they turned into a full fledged DKA attack.

((hugs)) to you and yours. Sending healing prayers to your kitty. And what a sweetie of a hubby you have! :smile:
 
Hi Kris,
My Jack was in DKA when first diagnosed as well, and had a bad vet experience. I was mad at myself too for not seeing all the signs and not wanting to believe something was wrong. But you have to put that behind you and just go forward now and do the best you can for Lois. You are in the right place and there are many wonderful people with great experience here to guide you along the way. Before Lois comes home make sure you read the info and get your testing supplies and all you will need to take care of her.

I have 2 non-diabetic cats and when Jack came home, I just switched them all to wet food. I was lucky that they all made the switch fairly easily once they knew that was all they were going to get!

It is all very scary and overwhelming at first, but you will feel better after a few weeks and a new routine. I see you joined the board right around the time my Jack was first diagnosed too...early April. And now, he is doing great.

Good luck to you and Lois and I hope she is home soon!
 
I was standing downstairs pondering where to put Nora's kibble (our Maine Coon who won't eat more than a bite or two of wet food) and just had a head-slapping doh moment.

Lois cannot jump a baby gate. Neither can Casper. Our Maine Coon cannot be contained by anything less than a locked door, and even then I wouldn't bet on it. I have two rooms gated off because the former tenants had a dog who destroyed that carpet and Lois is drawn to it. Dry kibble in dining room on far side of gate. Nora can clear gate, nobody else can get to it. One thing down.

Does the stress of all of this make one stupid? Really, normally I am considered a capable human being.

I am rearranging things and scrubbing Lois' bathroom from top to bottom. She has a private litter box and her own food/water upstairs. The princess demands such things, but it might make things easier because I can more clearly see what she is doing, without hovering, since my home office is on the far side of her loft. She is used to coming downstairs to eat wet food and steal kibble from the communal bowl, but I am hoping that her natural laziness plays to my advantage. Things got pretty bad last week when she was so sick and vomiting everywhere. I now have freshly cleaned rugs. That's a small good thing, right?

I am making lists - supply lists, question lists, to do lists. I function better when I have a plan. OK, I confess, I am anal-retentive, but in this case, I think that's not a bad thing.

Tomorrow's to do list includes starting her spreadsheet.

I have a meter thanks to Lori and Tom. And yes, I saw her post, and wept copiously today. After our roller coaster ride this week, I couldn't stop sobbing and had to leave the thread.

I got more strips today and more lancets. I abused a poor teddy bear with a syringe today, trying to get back into the groove so I can do this. My dad is a diabetic, and I still remember how to give a person a shot and all of the other things they taught us in a class for kids of diabetics - almost 30 years ago. Must have made an impression I guess.

I have a hypo kit started now. The signs and symptoms and instructions are posted inside the cabinet door, the kit is in a plastic container. I set up a recurring reminder on my calendar to remind me to switch out strips every 3 months so they don't expire.

And now I am going to have a glass of wine, try to breathe, and go to bed.
 
I wanted to say welcome, Kris and Lois, to the best place you never wanted to be. It sounds like you are getting your head around this situation and will be well prepared when Lois comes home.
 
((HUGS)) to you, Kris. What an ordeal!! So glad your girl will be coming home soon... your husband truly is an angel. Lois is so blessed to have you both.

A few questions and suggestions for you as you start the sugardance....

1. In addition to picking up test strips for your meter, pick up some ketostix. These will be very helpful in keeping an eye on Lois' ketone levels and in preventing another DKA attack. Alternatively, I believe one of the novamax meters will test blood for ketones, but I know the strips are pricey. I believe Violet uses one for dear Garland.

2. It is awesome that Lois gets her own litterbox. Is she really picky about litter? You may want to try the Breeze litter system. It traps urine in a tray below the litter on these pads, but what is great is that you can remove the pad and voila... urine sample for ketone testing! Makes it much easier than trying to catch her when she's going!

3. One other thing to pick up is a bag of FD appropriate cat treats. If you give a treat with each ear poke, you'll that Miss Lois will most likely become a very willing patient quite quickly! We use Purebites freeze dried chicken breast, but we get the dog bags... larger bag, and better cost per ounce. You can find them at Petco and other stores (the purebites site has a search function so that you can find them near you!).

4. Do you know what insulin you're going to be using? If it happens to be Lantus or Levemir, ask the vet to prescribe the pens in lieu of the vial. Unless a cat has a condition that requires a very high dose of insulin, much of the insulin in the vial will go to waste before you can use it. The pens are more expensive up front... $205 for 5 of them, but because you throw away less, it is a more economical option. Some Costco and Sams Club pharmacies will sell you one pen at a time, as will some outpatient pharmacies at hospitals, so call around. You don't have to be a member at Costco or Sams to use the pharmacy... it's illegal in every state to have members only pharmacies. People also have very good results with Prozinc insulin, but I would question the vet if they try to have you using Humulin N insulin... it is not a good fit for cats.

5. For syringes, Walmart is a good option to get started if you get one of the human insulins. Their house brand is called Relion, and you get 100 syringes for just over $12. The vet may include syringes with your insulin script... we ended up with BD syringes... $30+ for only 90! With the Relion ones, you've saved enough to cover the ketostix! You'll want the U100 syringes, 3/10cc, 5/16" in either 30 or 31 gauge. Whatever brand you end up with, this detail is important... you want syringes with 1/2 unit markings. You will get to a point where you will be adjusting Lois' dose in 0.25u increments, and it is virtually impossible to accurately measure on syringes with only 1u markings.

6. Once you have gotten started and then need to reorder supplies, you should look at ADW. They have the best prices outside of ebay for test strips and quality syringes (several of us are big fans of monojects, which they carry). If you happen to be using Walmart's Relion Confirm meter (a very econcomical choice), they sell the generic version of the strips for much less than WM. There are coupons floating around on the internet, they offer free shipping for purchases over $100, and there are cashback sites like that offer additional savings. Every little bit helps!

Once you know what insulin you'll be using, please head over to the forum here for that insulin. There is valuable information contained in the stickies there that will be of great help in explaining how our insulin works, how to adjust doses, signs to look for, etc. I suggest printing those out and putting them in a binder so that you have them for reference later. I always got so frustrated when I knew I had read something, but then needed the info quickly and couldn't remember what sticky I saw it in! having paper copies allowed me to scan more quickly, take notes, etc. I put the number for my vet and the emergency vet on the cover so I never had to search in the event I needed it quickly.

Sorry to throw so much info at you... I just know the financial and emotional strain that an FD diagnosis can bring... plus DKA... eeks! :shock: :shock: Hopefully these tips will help you as you get started. Please continue to ask questions as you have them... you'll find that we are a big family here and folks are very generous with their time and knowledge.
 
Kris,

Just wanted to welcome you and Lois to FDMB. It sounds like you are pretty well organised and ready to have your Lois home. I don't have any experience with DKA; therefore, I am sorry that I won't be able to give you any adivce but will give you moral supports.

I am very touched by your DH's understanding and compassion. Lois is a very lucky girl to have you both as her parents. Sending her lots of good vibes.
 
Re: what a roller coaster - DKA - and now bright red skin

Thanks guys. We're reading and learning and trying to have everything in order for when she comes home. Being organized helps my calmness level. I am making her some treats in the dehydrator today.

Just got off the phone with her doc. She's in a specialty hospital and since it was over a weekend, I think she's seen 3 vets so far. I have liked all of them, and they are so gracious answering my million questions. We moved to Atlanta 7 months ago, so I don't have my trusted network and feel like I am floundering a bit. I fired her former vet, and have 2 candidates to interview on Monday.

Her BG has been very responsive to the Lantus, and she was below 200 so they didn't shoot this morning. He thinks her dosage will be 1 unit once a day. Prefers to start low and go slow, which makes me feel better. Will verify that before discharge.

We have a new problem. When we visited yesterday, we noticed that her skin is bright red, and she is very flaky and dandruff is everywhere. It's all over most of her back, but her belly is the normal pink, and it's not on her head. This only happened after we saw her Friday night. I can get pics when I go this afternoon. Nothing raised, just bright cherry red. Our other 2 cats show no signs of this. Their dermatologist will examine her tomorrow, so for now I am waiting and worrying. He said it could be anything from an allergic reaction, to mites, to ringworm or some kind of fungus or god forbid, skin cancer. What on earth do we do now? Is this something she could have picked up in the hospital?

I was going to ask about checking for ketones. She is a bit litter fussy (as opposed to Casper who has strict and unyielding expectations as to how litter boxes are managed), but I am wondering if I can get her to use the Breeze. She likes clay, and absolutely refused to use the yesterday's news in the hospital, but it's worth a shot. So I can get strips and test that? Hm, that would help me sleep at night.
 
I am new here but please ask the more experienced members about dosing once a day with Lantus. Please do ask them as I am not sure about that. They will sure know more about it than I do.

Terri
 
Kris,
Next time you talk to the vet, ask him if .5 units twice a day (12 hours apart) would be okay? Lantus should be shot every twelve hours, same dose each shot. If he's saying 1u a day, hopefully he plans on 1/2 unit 2x per day.

As far as the litter goes.... just like most kitties won't go from one type of food (dry) to another (wet) right away, most kitties don't like a total sudden change in litter. You may need to try "weaning" off clay by gradually introducing something else. I have found two kinds that work well, "World's Best Cat Litter", and "Feline Pine" (not the pellets, but looks more like sawdust). I don't know if there is a way to transition to the "breeze" system, but somebody must know....

I have no idea as to the red skin issue. If it just appeared in the last few days, it sounds "allergy" related.

Carl
 
Thanks guys. I am reading and learning much.

I went to visit Lois this afternoon. She's at a specialty hospital, and her doctors and nurses are very open to dialog about her appearance and behavior and treatment. They concede that I know her best, and communicate what I tell them to her care team. If only I could find that in a PCV!

We have to find a new primary care vet right away, because this place is only a hospital. I REFUSE to take her back to the one she was seeing. It was so bad. Still angry about it, and I had carefully researched it. Several people I've talked to say there are many vets to avoid in this area and I have a list of "avoid at all costs vets" longer than possible candidates. Her internal medicine doctor said he'll help us find a local vet with experience in diabetes who will work with us. There's also a TICA cat show here this weekend, and a friend of our Nora's breeder is local. She is going to introduce us to some other breeders and see if we can do some research on vets.

I am hoping the rash is just a reaction and goes away. It didn't appear as bright red today (wishful thinking?), but today she was sneezing a bit, which is very unusual. They'll watch her to see if it continues. She'll be checked by their dermatologist tomorrow. Today she didn't want down off the table when they brought her out to visit. Yesterday she stomped all over the exam room. Today she snuggled in her blanket cocoon and purred and let me pet her, but couldn't be bothered to explore. I am encouraged by her attitude making a comeback - apparently she is smacking at her nurses when she is tired of being poked. This is good, I think. Lois is crotchety and cranky. A well-behaved and cooperative Lois is sick Lois.

She continues to eat everything they give her. Her appetite is back with a vengeance. The more I read here, the more I realize how lucky we are. This tiny kitty is a fighter.

Asking about the Lantus dosing schedule is on my list. I've been busily reading the stickies in the Lantus forum, and it seems it works best over 12 hours? I'm on information overload right now.

We're going to have a lot to learn when Lois comes home. They said she may need sub Q fluids for a while, since she was so dehydrated. I'm nervous about giving those. Our Casper had them at the vet recently and she didn't take it well. I hate needles. I know I will cry the first time I have to do the prick and the shot alone. I also know that I have to do it, and it will get easier. I was studying Lois' ears while visiting her today. Because her ears are black, it's so hard to see that vein. They're so tiny, and she twitches them like mad when I try to touch them.

If all goes well, Lois comes home tomorrow night. I am thrilled, and I am scared. She's counting on me to get this right.
 
Kris,
They should be showing how to do the sub-q fluids before sending you home with the setup. Many people here have had to do this at home, so if you have any questions, ask. Tell them you would like 22g thin walled needles. They'll know what that means. They are smaller than the "standard" 18 gauge ones. It takes a bit longer for the treatment, but the needle will be nicer for Lois.
Testing and shots? You'll have all this down very quickly. You won't realize how easy it becomes until it "does", but we promise, it does get easy. Everyone worries that they'll not do things correctly, or that it hurts kitty. Trust me, the first few tests are much harder on you than they will be on Lois. Just make sure you feel good about it before you leave for home with Lois. It's all about self-confidence, and if you need them to explain or demonstrate something one more time, ask and they will.

Once you get home, and think "oh no, I forgot everything they told me!!!!"??? Just post on here, and no matter what it is that you are needing to do, somebody here has done it, and can help you, even as far as a phone call to talk you through it step by step.

This time tomorrow, you should be home with Lois safe and sound. Looking forward to hearing about it! And remember, now that you are "here", you're never alone.
Carl
 
Talk to the receptionist at your emergency clinic... I actually got a referral this way and it was a huge help! they often know many of the vets in town (or can quickly find you someone who does!). I told mine that I was looking for a vet that would be supportive of the FD protocol I was following (the one we use here in the Lantus Forum) and who was willing to be a partner rather than a dictator, and who could assist me when needed but who would let me deal with the day to day handling of Willie's FD and not try to micromanage his care. We were eventually able to find a couple such vets! You may want to post over in the Lantus forum and see if anyone is nearby and would have a recommendation!
 
I have a meter that tests for Ketones I can send you. I have a spare (thanks to the wonderful people here) Let me know if you want it. :smile: I will say, the strips are CRAZY expensive. I try to urine test when I can to save the strips. I can tell now based on her behavior when her Ketones are getting higher. Her appetite decreases dramatically when the Ketones are there. But the wonderful thing about the meter, is if you want fast accurate results, with a prick of an ear, you know for sure whats going on.

I had to do SQ fluids here for her just last week bc of ketones. Its easy once you get the hang of it. But yes, very intimidating and scary the first time. I found it was easier to be in a quiet room, hang the bag up high and hold her in my lap. A quick poke and some petting. It would take about 60-90 seconds for 100cc to go in. then I gave her a treat and a kiss and she was off and running LOL It leaves a little pocket of water that absorbs over time, but she didnt seem to notice.

But after the DKA stuff Ive been through, I am a STRONG believer in ketone testing. Those things can sneak up out of no where on you. If I hadnt caught the rise last week, we would have been right back in the hospital with anther big bill. Test for ketones as often as you can. Some food, insulin and SQ fluids can fight them away.

Good luck!! and ((hugs)) to you!
 
My cat has had DKA four times. Most cats get DKA only when they are first diagnosed or unregulated. Some are prone to ketones and will need to be monitered for ketones for the rest of their lives. I have a ketone prone kitty. Yes I would be mad at your vet too but you need to focus for now on when your kitty comes home. Ideally, you could find a 24 hour vet so you don't have to deal with the seperate emergency vet and regular vet. The prices they quoted you also seem totally out of line. Even Nomad's most expensive episode was about three thousand.The meter the other member mentioned is probably the precision XL. It takes different strips for ketones that are six dollars a piece. I use mine only when Nomad shows signs of ketones but it was worth the investment.There are many cats here that have recovered from DKA. I wouldn't worry too much about the skin flakes at this point. Many diabetic cats get the skin flakes when first diagnosed but it usually improves as the diabetes becomes regulated. I know this is a difficult ordeal but we have our paws crossed for you.
 
Thanks guys. I have a feeling that you guys are my only help of keeping my sanity.

Violet, I would love to have that ketone meter. Thank you so much. I am frantic about being able to test for them so I can watch her better. As for the strips being crazy expensive, well isn't this whole thing wildly expensive? I make good money, but have had to spend so much on her care in the last few months that I am feeling very pinched. I'll get through it, but I am motivated to keep her feeling good so I can build up her hospital fund again. My dad offered to send me a meter, but I have one that Lori and Tom sent. I will probably get a Relion meter since I'll probably be going to Walmart anyway to get needles. Then I'll send Lori all the other meters and pay it forward. Told dad to ship me those extra meters, that there are kitties in need. Have lots of scrap fabric left from my last quilt too, so I bet I could whip up some more rice sockies in no time.

I bought a Breeze litterbox. There are instructions on their site for getting a cat to switch gradually. It's worth a shot. I threw out Lois' old box and replaced it with an identical one with new litter. No chance risking that I missed anything, especially with the mystery rash. Once she gets home and is settled for a week or so, I'll put a handful of those pellets in her existing box and start the process. She has her own large bathroom - and it's huge. Double vanities for a cat anyone? Scrubbed it down ceilings to floors yesterday, and rug scrubbed all of the carpets where she hangs out. (She had thrown up everywhere.) She's very territorial about her bathroom and her food bowls, so I will stop correcting her and encourage our Maine Coon to use the downstairs facilities. Thanks goodness she's so laid back and tolerates the grumpiness of her senior sisters without missing a beat.

Thanks for the suggestion. Since the Lantus seems to be working, I want to find a vet who will be supportive and recognize that I am going to ask questions and want to drive her daily care. I do know her best, and really need a partner in this. I'll pop over to the Lantus forum and see if anyone there has vet suggestions.
 
Welcome to FDMB. What a time you've had!

Many of us have cats who have started this journey with an episode of DKA. FWIW, Gabby was also hospitalized with DKA, pancreatitis and hepatic lipidosis at the time of her diagnosis. She responded well in the hospital. We did not need subcutaneous fluids when she came home so some of this varies from cat to cat.

If you need it, this is an article on the Lantus dosing protocol. It's from a leading vet journal and is a good way to support your questions and to help inform the vet(s) if they are pushing for once a day dosing. Going armed with information can help, especially if the information comes from a vet journal.


You might want to take a look at your post on the Lantus forum. Georgia/Simon are from your area and have a suggestion regarding a vet.
 

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The coaster ride continues. Vet just called, and he and the dermatologist share our concern about the skin redness. They're doing a skin biopsy because the severity and quick onset bother them. Think it may be auto-immune response to meds, but it could be lymphoma. (Please God, please no cancer, this brave baby girl doesn't need that.)

So they are doing the test now, and we wait on pins and needles, praying for good results.

The good news is that they are feeding her FF classic (and they know who Binky is :-D ) and her numbers are low with diet. Haven't been able to shoot her since yesterday morning. The doctor was worried about putting her on Lantus even on such a low dose. He was happy to hear we're going to home test. Told us we are gonna have to watch for hypos, but that he is optimistic she can do it (will not jinx myself and say it) in relatively short order if we cam strictly control her diet. Urine tests free of nasty ketones.

Georgia and Simon, Linda Lee and Napoleon are close by, and have offered to help, and I am indecently relieved.
 
Lois is coming home from the hospital tonight. She had been eating like a champ through this whole thing, and now she's not eating much. Yesterday they did a biopsy to identify the cause of her sudden red skin, and ever since the procedure her appetite has been off.

She's coming home tonight - the budget cannot stand any more of the hospitalization and the vets can't put a medical reason on it. She hasn't had any Lantus in 24 hours and her BG has remained below 200. I will post data tonight when I get it all.

They are sending her home without insulin and cannot tell me why she had such a bad DKA incident and now is holding her own. Can't find any underlying medical cause. Supposed to be in for a recheck on Friday, or bring her back sooner if she won't eat.

I'm really worried now.
 
Hello Kris and Lois,

I just had a really horrible experience myself with DKA and my Dude. He was in the ER for 5 days and it cost about 4k. He cleaned me out pretty good but that's fine, its only money :) Anyway, he would not eat a thing while he was at the Vet so when we brought him home they told us if he didn't eat within 12 hours we'd have to bring him back. We very slowly got him to eat just the smallest amount of food as often as we could. Last week for some reason he completely lost his appetite and even now he really doesn't want to eat anything but Tuna (tuna and prawns wet food to be exact). We tested him for ketones several times and each time they were slightly elevated. You know sometimes how you can just tell something is wrong even though they look and test fine? The last few days he's been much better but we do just have to pay attention every hour of every day. It's well worth in my opinion and I can see you feel the same. Hang in there. Test if you can. Give kitty a kiss for me and Dude.

tmjn
 
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